01040118 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS; PHRMIT No
20200 LUCILLE AV # 73—"6 ROYAL ROOFING 010401. 1.8
OWNHR'S NAMIi: APPLICATION SUB DATE
STONESON DEVELOPMENT CORP THE 1345 VANDER WAY 04/23/2001 '
• PIIONI?'. SANITARY NO. CONTROL NO,
(408) 279-21'32
M is O Z ARCHI TECs/15NGINEHN: BUILDING 1'HRMI'E INFO
BLIIG ELECT PLUMB MECH
2
S Y`t LICENSIID COurencade, DHCLA RATION - Job Description
ZO z_= 1 nonny affirm than 1 um lif,hc B under pm Pod1c of Chapter 9 aommendne
f,y_= w'dh Section 700)(0 IIuf Division Sof tM1e Nu%incss and l'rnl?rsionx Code.and my license
a mmnronenn}tefre,t. 7(grtq RE ROOF REMOVE SHAKES INSTALL 1/2 CDX
O w U Liab.sc CL S Q' Lic,# ,7
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r n.t- Uwe _o col�t.ae __ G
wsnm ARCHITECT"SUHCLARAIR)" f" CERTAIN FEED SHINGLE
t=O 5 1 understood my plans shall M used as public accord.
�y¢to
leg I O Llce oll Pode.eional
as.to OWNbR-BUII.DIiR DECLARATION
uci n I bereby affirm that 1 ant excaNl man the Commctor's License Law for the
F Z< fnllo„ing namn.(sermon 71131.5.Business and Professions CMe:Anv city or county
o which requires a permit u,Conrwct.alter,improve demolish,or repair any shuchme
now a5 prat t Lo 4 rh killas tf nc nnev is 'g Jcuncmem
(con 1 dl ui n d P - rev Ito t Iamorsf Law(Chapter Sq. Fl. Floor Area Valuation
lu,bar he is a with S,cbOnom aoI a Division 3 of the Business and Polion.An,vi Gale)
.,,bar Section
is swops maemfrm and the basis for the alleged exemption.Any violation
of Section](131 S by any applicant for a permit subjects the applicant in a civil penahv
of manual him fie,hundred dollars(sink)), APN Number OCCUPVv &goo
0Lasowns,tot the pmpeny....rimy entptoyees with wage.,a,oncasole com,l iron.
sill do the walk. ad he mactime I,no0intended offered for al sce.Tw.
Ba,m,s,andnfe. Cod The c tr• t I Lm,doc,net applytoan 31.602094'�r bed Inspections
ownert property Whon es to J n d n k himself
S
,it 11. yl,his au eauploye, novaill tl ch I.overnana,are I,),included or /
offered for sale.If.now the nuking or improvialano isstill%iflum one year of
c /
rnnpl r to ceb[c de 'R have the burl r proving that n did not Ixsdd or 305 — FRAME C
mpmsc for pmtro%a of,ales). 307 — INSULATION
❑1,m owner ofd¢nro,ercy,an,exclusively coobueoing with licensed emntianom w
usurer me project(See.70,14,It and Promxshbs Came.)The Contractor's 601 — ROOF TEAR OFF
consumer
�icense Law docs ant a,Ny ,,an own,,of pnpeny who build.,or improve,thereon,
and who contracts for.urn project,with a eommlum)licensed pursuant it) 602 — ROOF PLYWOOD NAIL
Commcmh Lieenxc Law.
o lain e.e.mtpt lodes S,t. n r r,n,r tnix ria%o 603 — ROOF BATTENS
Owns _ awe �1lzI �r 604 — ROOF IN—PROGRESS
0 0.' COMP[NSATION DECLARATION
1hcsnyo of penury omens dm oll—no,deelamrionx.
0 1 have and will maintain a Ccnificato of Consent to wit-insub for W'orkcrs ,
Cnntpenwrion, as provided for by Section 3]1X) of the Labor Code, for the
,Hormanee of the work li,r which this Imeunit k issued
and will ntninmin Worker's Cnmpenmlin I Imuranro,us ro,on d In,Section
311X1 of rhe WM,r Axle,for the cerbarmarec of the work for„hien this permit is
issued.My Worker's Compensation Inxuonce ewrier um1 Policy number are:c
Carjet:AX.Tj�I, , S`e_'N cy No.: :/ rlDO7.3p�UI
CURTII9CAI'ION OF E%IiM19HON FROM WORRIERS'
COMPENSATION INSURANCE
QTiz section need not be co riplered if rhe permit is or one hundred dollars
S XnorIcs.v) -
1 cerfl y that in the prrlourral cc of the woe,fur which this permit is issue,I
,hall nor employ any ,,an in any moaner w s em Iceomc subject m the Workers'
Gnii'malion laws of Coliforms Dwc
Applicum
NUI ICH TO API'LICAN'1:It,alter makin6 this Cellilir m of 17sc a,dion,you should
barbarroom,romsubject m be Worker's Compensation provisions oto
f the Luton Cattle.you mast
Q O forth„irh comply with such provisions or chic permit%hall be deemed revoked.
Z ..
= CONSTRUCTION Lt?NDI NO AGENCY
a ' hkfor which thin then is a,sued(Sec. IcnJi C agency for the penin mance
Lea work me which this non is ixsmJ(Sec.3rM1].Ci¢OI
L 0 I.en.kr's Name
Q Z LenJer'vAddress
V Q I ecuil'y than 1 hove.cuA this u,lWntmc and nmte Ihnl till[chose Iborno I is _
4. P cmrter.1 agree it,cunply with all city and county ordinances and state laws relating
Q U to budding comwnion.and hereby[cmhttio,npnsentwivo ofthi%city lumber upon
the airloc-incintioned property lot no,socconp rint
[^.. 4 (We)agrerot ove.rallonairy andkeep h sxohs C'tY t Cattleman,again,
V] I'tblt ....I6oln,.•c is d 1 ccs Mach may litany way agin, aid
V z City' 4 curve or n Nnoting IIIThis'mi
SOUICERGULATIOTANDS AND WILL COMPLY WITH ALL Issued by' r�ti77/wCC.it eIe Z
I:nurc of Appllc[cMVARDU J`-lailT, to Re-fool's
HA9,A RDOU' IRIS DISCLOSURH
WrrlltIN applicant or fun (ding reeapaat Nose or haaale naardoas material Type of Roof
as Jelined by the Cupertino Municipal Cute,Chapter 9.12,and the Health and Safety
C...I,Section 25532(x)1
O Yes 5tr o _ All roofs shall be inspected prior to any roofing material being installed.
Will he vpplicant ,,future building occupant use ca,mp.ncut or dn'ices which If a roof is installed without first obtaining an inspection, I agree to remove
emit haazmJ.ns air comeaminmm as defined by the Bay Acca Air Quality Management
District' all new materials for inspection. Applicant understands and will comply with
ClYe r all non-point source regulations.
1 have read the harardou%InmcrinH ry mmmcnts under Chapter 6.95 of the
California Ilcalth F Safety Cute.Sections 25505,25533 and 25534.1 amh,,and dmf /
icon,bulldingdoesno,curtcmly haven nnbn,that it is my responsibility to notify the
I'll A the regoi nano which...[cLI be incl Pti.r m."unciw of a C'crlilica,nr
roc —�.
D`capney' , ignature of Applicant
3 Date
r.t
omarr d agern Date Al roof coverings to be Class•B" or better
OFFICE